Smith Jonathan H, Amer Mohammed A, Schwedt Todd J
Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA.
School of Medicine, The University of Jordan, Amman, Jordan.
Headache. 2021 Feb;61(2):396-398. doi: 10.1111/head.14072. Epub 2021 Feb 24.
To empirically address how thunderclap headache (TCH) is described in a relevant real-world setting.
TCH refers to a highly recognizable description of a severe headache that reaches maximum severity within 1 minute and endures for at least 5 minutes. The use of a numerical rating scale (NRS) to appraise TCH severity, as well as assessment of TCH progression in patients with pre-existing headache at the time of TCH onset has not been previously evaluated.
This was a retrospective case series of adults with a diagnosis of reversible cerebral vasoconstriction syndrome (RCVS), identified through a search of the electronic health record. Individuals meeting International Classification of Headache Disorders, 3rd Edition criteria for acute headache attributed to RCVS were included. Attacks described using a verbal descriptor scale (VDS), NRS, or both were recorded to evaluate acute headache characteristics.
In all, 56 individuals with available descriptions of 120 acute headaches were included in the study analysis. Patients were female (35, 62.5%) with a median age of 46 (range: 19-67). The majority of patients reported a RCVS trigger (39, 69.6%). Acute headaches were characterized using a VDS (52, 43.3%), NRS (51, 42.5%), or both (17, 14.1%). Acute headaches were always described as severe when a VDS was utilized, and with a median NRS of 10 (range: 4-10). Four patients (7%) did not have a single headache characterized as either severe or with a NRS 8 or greater. In the 10 cases for which there was a pre-TCH baseline headache, it was either rated as mild or with a median NRS of 3 (range: 2-6).
TCH in RCVS can be recognized using either VDS or NRS, with a broader range of peak intensities than previously recognized. TCH remains recognizable despite pre-existing baseline headache.
通过实证研究探讨在相关现实环境中霹雳性头痛（TCH）是如何被描述的。
TCH是指一种极易识别的严重头痛描述，头痛在1分钟内达到最大严重程度并持续至少5分钟。此前尚未评估使用数字评定量表（NRS）评估TCH严重程度，以及在TCH发作时对已有头痛患者的TCH进展情况进行评估。
这是一项回顾性病例系列研究，通过检索电子健康记录识别出诊断为可逆性脑血管收缩综合征（RCVS）的成年人。纳入符合《国际头痛疾病分类》第三版中归因于RCVS的急性头痛标准的个体。记录使用言语描述量表（VDS）、NRS或两者描述的发作情况，以评估急性头痛特征。
共有56名有120次急性头痛可用描述的个体纳入研究分析。患者为女性（35例，62.5%），中位年龄46岁（范围：19 - 67岁）。大多数患者报告有RCVS诱因（39例，69.6%）。急性头痛通过VDS（52例，43.3%）、NRS（51例，42.5%）或两者（17例，14.1%）进行特征描述。使用VDS时，急性头痛总是被描述为严重，NRS中位值为10（范围：4 - 10）。4名患者（7%）没有一次头痛被描述为严重或NRS为8或更高。在有TCH前基线头痛的10例病例中，基线头痛要么被评为轻度，要么NRS中位值为3（范围：2 - 6）。
RCVS中的TCH可通过VDS或NRS识别，其峰值强度范围比之前认识的更广。尽管存在基线头痛，TCH仍然可被识别。
